Quantitative Magnetization Transfer MRI Measurements of the Anterior Spinal Cord Region are Associated With Clinical Outcomes in Cervical Spondylotic Myelopathy

Cloney, Michael; Smith, Zachary A.; Weber, Kenneth A.; Parrish, Todd B.

doi:10.1097/brs.0000000000002470

Cited by 27 publications

(29 citation statements)

References 37 publications

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“…SCT contains a comprehensive set of tools for the processing of multi-modal spinal cord MRI datasets including the PAM50 spinal cord standard template (resolution = 0.5 × 0.5 × 0.5 mm 3 ) with a corresponding probabilistic atlas of 15 pairs (i.e., left and right side) of white matter tracts as well as functions for multi-modal registration and spatial normalization (Fonov et al, 2014;De Leener et al, 2017;Dupont et al, 2017). The individual white matter tracts within the anterior, posterior, right lateral, and left lateral spinal cord were combined to quantify the amount of spared tissue within these white matter regions (Cloney et al, 2018). Spatial normalization is the process of bringing the subjectlevel images into spatial agreement with a standard template.…”

Section: Spinal Cord Mri Analysismentioning

confidence: 99%

Spinal Cord Imaging Markers and Recovery of Volitional Leg Movement With Spinal Cord Epidural Stimulation in Individuals With Clinically Motor Complete Spinal Cord Injury

Rejc

Smith

Weber

et al. 2020

Front. Syst. Neurosci.

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Section: Spinal Cord Mri Analysismentioning

confidence: 99%

Spinal Cord Imaging Markers and Recovery of Volitional Leg Movement With Spinal Cord Epidural Stimulation in Individuals With Clinically Motor Complete Spinal Cord Injury

Rejc

Smith

Weber

et al. 2020

Front. Syst. Neurosci.

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“…New advancements in MRI acquisition and analysis techniques have recently expanded our ability to non-invasively investigate the spinal cord with high-spatial resolution ( Alley et al, 2018 ; Stroman et al, 2014 ; Wheeler-Kingshott et al, 2014 ). Advanced structural spinal cord imaging techniques, including diffusion-weighted and magnetization transfer MRI, are showing promise at linking spinal cord pathology to a patient’s clinical state as recently demonstrated in cervical spondylotic myelopathy, multiple sclerosis, amyotrophic lateral sclerosis, and incomplete spinal cord injury ( Cloney et al, 2018 ; Eden et al, 2019 ; Hopkins et al, 2018 ; Maki et al, 2018 ; Martin et al, 2017 ; Paquin et al, 2018 ; Smith et al, 2018 ). Functional MRI provides a means to measure neural activity using the blood oxygenation level dependent (BOLD) contrast and is routinely used clinically for pre-surgical planning to localize brain function in relation to the brain pathology ( Nadkarni et al, 2015 ; Ogawa et al, 1990 ).…”

Section: Introductionmentioning

confidence: 99%

Assessing the spatial distribution of cervical spinal cord activity during tactile stimulation of the upper extremity in humans with functional magnetic resonance imaging

et al. 2020

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Dermatomal maps are a mainstay of clinical practice and provide information on the spatial distribution of the cutaneous innervation of spinal nerves. Dermatomal deficits can help isolate the level of spinal nerve root involvement in spinal conditions and guide clinicians in diagnosis and treatment. Dermatomal maps, however, have limitations, and the spatial distribution of spinal cord sensory activity in humans remains to be quantitatively assessed. Here we used spinal cord functional MRI to map and quantitatively compare the spatial distribution of sensory spinal cord activity during tactile stimulation of the left and right lateral shoulders (i.e. C5 dermatome) and dorsal third digits of the hands (i.e., C7 dermatome) in healthy humans (n = 24, age = 36.8 ± 11.8 years). Based on the central sites for processing of innocuous tactile sensory information, we hypothesized that the activity would be localized more to the ipsilateral dorsal spinal cord with the lateral shoulder stimulation activity being localized more superiorly than the dorsal third digit. The findings demonstrate lateralization of the activity with the left- and right-sided stimuli having more activation in the ipsilateral hemicord. Contradictory to our hypotheses, the activity for both stimulation sites was spread across the dorsal and ventral hemicords and did not demonstrate a clear superior-inferior localization. Instead, the activity for both stimuli had a broader than expected distribution, extending across the C5, C6, and C7 spinal cord segments. We highlight the complexity of the human spinal cord neuroanatomy and several sources of variability that may explain the observed patterns of activity. While the findings were not completely consistent with our a priori hypotheses, this study provides a foundation for continued work and is an important step towards developing normative quantitative spinal cord measures of sensory function, which may become useful objective MRI-based biomarkers of neurological injury and improve the management of spinal disorders.

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“…Recent studies have shown that chronic injury to the cervical spinal cord with spondylosis can be non-uniform and associated with tract-specific injury [26]. We have previously shown that anterior spinal cord compression and injury, as quantified by advanced MRI metrics, will predict symptoms of clinical myelopathy [27]. Further, our work shows that that specific descending motor tracts (ex: reticulospinal tract) may be most heavily impacted by cervical spondylosis [28].…”

Section: Resultsmentioning

confidence: 63%

Assessing hand dysfunction in cervical spondylotic myelopathy

et al. 2019

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Cervical Spondylotic Myelopathy (CSM) is a common spinal condition that presents as hyperreflexia, loss of dexterity, and strength. Despite its prevalence, little is known about the specific neuromechanical deficits that constitute overall disability in CSM. Compression on MRI doesn’t exclusively relate to disability. Moreover, clinical assessment often relies on the subjective exams and self-reported questionnaires. Therefore, the purpose of this study was to assess hyperreflexia, proprioception, and loss of strength, and its association with common MRI scales.MethodsTwenty patients with CSM and 17 controls were recruited. Clinical scores of modified Japanese Orthopedic Association (mJOA) and Nurick were collected. MRI based compression grades such as cord distortion were assessed. Hand dysfunction was tested using a custom motorized apparatus. Subject’s forearm was placed in a cast and positioned such that their metacarpophalangeal (MCP) joint was vertically aligned with the motor shaft. Surface electromyographic sensors were placed on flexor digitorum superficialis (FDS) and extensor digitorum communis muscles. Hyperreflexia was measured as the FDS muscle activation during reflex when the MCP joint was moved from flexion to extension at 300°/sec. Proprioception was quantified as the angle of detection in absence of visual or auditory cues (subjects were blindfolded and given noise-cancelling headphones). Strength was measured as the maximum isometric force at the MCP joint. 2-sample t-test (p<0.05) were performed to assess significant differences in reflexes, proprioception and strength among patients and controls (SPSS software version 24).ResultsPatients reported higher Nurick (1.90±1.0 vs 0±0, p<0.001) and lower mJOA scores (14.3±1.9 vs 18.0±0, p<0.001) as compared to controls. Similarly, patients with CSM had increased reflexes (peak FDS EMG) (0.073±0.096 vs. 0.014±0.010, p = 0.019). Patient proprioception was significantly worse; mean angle of detection was greater than twice as high in patients (9.6± 9.43°) compared to controls (4.0± 2.3°), p = 0.022. MRI based compression ratio (CR) was a significant predictor of hyperreflexia, CR<0.44 resulted in steep increase in reflex activity. Fifteen of the 20 patients who completed follow up testing at 6 months after surgery show substantial clinical improvement in reflexes and proprioceptive angle, while repeated testing in controls were unchanged.ConclusionIn conclusion, hyperreflexia and decline in proprioception are the main drivers of hand disability in patients with CSM. Of multiple scales, only a select few MRI scales (such as compression ratio) were predictive of increased reflexes. The study describes a pre-clinical testing apparatus to quantitatively and objectively assess primary presenting symptoms in CSM. This pilot apparatus has the potential to evaluate treatment efficacy through repeated testing. Objective testing of hand dysfunction can help inform the design of clinically feasible devices, guide MRI biomarker analysis, and improve our understandi...

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Quantitative Magnetization Transfer MRI Measurements of the Anterior Spinal Cord Region are Associated With Clinical Outcomes in Cervical Spondylotic Myelopathy

Abstract: 2.

Cited by 27 publications

References 37 publications

Spinal Cord Imaging Markers and Recovery of Volitional Leg Movement With Spinal Cord Epidural Stimulation in Individuals With Clinically Motor Complete Spinal Cord Injury

Spinal Cord Imaging Markers and Recovery of Volitional Leg Movement With Spinal Cord Epidural Stimulation in Individuals With Clinically Motor Complete Spinal Cord Injury

Assessing the spatial distribution of cervical spinal cord activity during tactile stimulation of the upper extremity in humans with functional magnetic resonance imaging

Assessing hand dysfunction in cervical spondylotic myelopathy

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